SB-0744, As Passed House, December 17, 2009

SUBSTITUTE FOR

SENATE BILL NO. 744

A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3829a.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 3829a. (1) This section applies to all medicare

supplement policies or certificates delivered, issued for delivery,

or renewed on or after May 21, 2009.

(2) An insurer of a medicare supplement policy or certificate

shall not do either of the following:

(a) Deny or condition the issuance or effectiveness of the

policy or certificate, including the imposition of any exclusion of

benefits under the policy based on a preexisting condition, on the

basis of the genetic information with respect to that individual.

(b) Discriminate in the pricing of the policy or certificate,

including the adjustment of premium rates, of an individual on the

basis of the genetic information with respect to that individual.

(3) Nothing in subsection (2) limits the ability of an

insurer, to the extent otherwise permitted by law, from doing

either of the following:

(a) Denying or conditioning the issuance or effectiveness of a

policy or certificate or increasing the premium for a group based

on the manifestation of a disease or disorder of an insured or

applicant.

(b) Increasing the premium for any policy issued to an

individual based on the manifestation of a disease or disorder of

an individual who is covered under the policy. However, the

manifestation of a disease or disorder in 1 individual cannot be

used as genetic information about other group members and to

further increase the premium for the group.

(4) An insurer of a medicare supplement policy or certificate

shall not request or require an individual or a family member of

that individual to undergo a genetic test.

(5) Subsection (4) does not preclude an insurer of a medicare

supplement policy or certificate from obtaining and using the

results of a genetic test in making a determination regarding

payment, as defined for the purposes of applying the regulations

promulgated under part C of title XI and section 264 of the health

insurance portability and accountability act of 1996, 42 USC 1320d

to 1320d-8, and consistent with subsection (2).

(6) For purposes of carrying out subsection (5), an insurer of

a medicare supplement policy or certificate may request only the

minimum amount of information necessary to accomplish the intended

purpose.

(7) Notwithstanding subsection (4), an insurer of a medicare

supplement policy may request, but not require, that an individual,

or a family member of that individual, undergo a genetic test if

each of the following conditions is met:

(a) The request is made pursuant to research that complies

with 45 CFR part 46, or equivalent federal regulations, and any

applicable state or local law or regulations for the protection of

human subjects in research.

(b) The insurer clearly indicates to each individual, or in

the case of a minor child, to the legal guardian of that child, to

whom the request is made, that compliance with the request is

voluntary and that noncompliance will have no effect on enrollment

status or premium or contribution amounts.

subsection shall not be used for underwriting, determination of

eligibility to enroll or maintain enrollment status, premium rates,

or the issuance, renewal, or replacement of a policy or

certificate.

(d) The insurer notifies the commissioner in writing that the

insurer is conducting activities pursuant to the exception provided

for under this subsection, including a description of the

activities conducted.

(e) The insurer complies with any other conditions as the

commissioner may by regulation require for activities conducted

under this subsection.

(8) An insurer of a medicare supplement policy or certificate

shall not request, require, or purchase genetic information for

underwriting purposes.

(9) An insurer of a medicare supplement policy or certificate

shall not request, require, or purchase genetic information with

respect to any individual prior to that individual's enrollment

under the policy in connection with that enrollment.

(10) If an insurer of a medicare supplement policy or

certificate obtains genetic information incidental to the

requesting, requiring, or purchasing of other information

concerning any individual, that request, requirement, or purchase

is not a violation of subsection (9) if that request, requirement,

or purchase does not violate subsection (8).

(11) As used in this section:

(a) "Family member" means, with respect to an individual, any

other individual who is a first-degree, second-degree, third-

degree, or fourth-degree relative of that individual.

(b) "Genetic information" means, with respect to any

individual, information about that individual's genetic tests, the

genetic tests of family members of that individual, and the

manifestation of a disease or disorder in family members of that

individual. Genetic information includes, with respect to any

individual, any request for, or receipt of, genetic services, or

participation in clinical research which includes genetic services,

by that individual or any family member of that individual. Any

reference to genetic information concerning an individual or family

member of an individual who is a pregnant woman includes genetic

information of any fetus carried by that pregnant woman or, with

respect to an individual or family member utilizing reproductive

technology, includes genetic information of any embryo legally held

by an individual or family member. Genetic information does not

include information about the sex or age of any individual.

counseling, including obtaining, interpreting, or assessing genetic

information, or genetic education.

(d) "Genetic test" means an analysis of human DNA, RNA,

chromosomes, proteins, or metabolites, that detect genotypes,

mutations, or chromosomal changes. Genetic test does not mean an

analysis of proteins or metabolites that does not detect genotypes,

mutations, or chromosomal changes; or an analysis of proteins or

metabolites that is directly related to a manifested disease,

disorder, or pathological condition that could reasonably be

detected by a health care professional with appropriate training

and expertise in the field of medicine involved.

(e) "Insurer of a medicare supplement policy or certificate"

includes a third-party administrator or other person acting for or

on behalf of that insurer.

(f) "Underwriting purposes" means all of the following:

(i) Rules for, or determination of, eligibility, including

enrollment and continued eligibility, for benefits under the

policy.

(ii) The computation of premium or contribution amounts under

the policy.

(iii) The application of any preexisting condition exclusion

under the policy.